HomeMy WebLinkAboutZ-6249 FOEM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z.~?v~.-.~.9 Date A~O~Ab.IP.....?.i.t.........., 19.~~!'.
THI5 CERTIFIES that the building located at ~?+t~p. H~?d Street
Map No. Block No... ~ .....Lot No...... ~ .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated X~ . 19 pursuant to which Building Permit No.. .
dated XXX . . . . . 19...., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .Used car business - Dis~la~ of not r~ore thAn Fifteen V®hlclaa
~wPPaa'1 ~1 ~ ~t~pisial 8ze~ptiaa) .
The certificate is issued to T!A.D. Auto Salas Inc. Thomas A. IhtSfey Prss.
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval , A: /R
N
UNDERWRITERS CERTIFICATE No .
HOUSE NUMBER 2995Q Street ....fain .lt(~aa,Z Cutcho~ue: .v'. Y.
i.
i'
Building Inspector
v • FORM NO. 6
~T ~ TOWN OF SOUTHOLD
,Building Department
Y ~'1 Town Clerks OFfiee
C,~' ~ Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ...~..f-....-.Z:S..-..~.~........
New Building Addition Old or Pre-existing Building Vacant Lond
Location Of Property .......,..~:~.~......~1-~..r.~.l...~./.+~~J..s9.,~;t.....-~.........~G,~T.G.rt/.Q~t~.~:~~r~
Owner Or Owners Of Property ~/...f.L~.~~X..S../..'1.~..1../~--l...d.~!:~
Subdivision .................--'........................................Lot No............. Block No............. House No~~?q.
~d
Permit No.......--........ Date Of Permit ....................Applicant
Health Dept. Approval .............-.........................Labor Dept. Approval
Underwriters Approval ...........................Planning Board Approval
Request For Temporary Certificate Finn) Certificate ......Y..............................,
Fee Submitted $
Construction on above described building and permit meets aJ,l applicable codes and regulations.
Applicant ~
/'j..
Sworn to before me t is ~ ~/4° - ~
day of ..tl:S.::~:.~.... . ~.~L...... (stomp or seal)~c ~ y Zi
Notary Public . County f/`
J r~